Individual
KWAME LARRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
25624 W 12 MILE RD, SOUTHFIELD, MI 48034-8048
(313) 914-8696
Mailing address
25624 W 12 MILE RD, SOUTHFIELD, MI 48034-8048
(313) 914-8696
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703116004
MI
Other
Enumeration date
08/09/2016
Last updated
08/09/2016
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